Nursing Elites

1. A nurse in a clinic is caring for a client who came to be tested for tuberculosis (TB) after a close family member tested positive. The nurse should know that which of the following is a diagnostic tool used to screen for TB?

• A. Sputum culture for acid-fast bacillus (AFB)
• B. Mantoux skin test
• C. BCG vaccine
• D. Chest X-ray

Correct answer: B

Rationale: The Mantoux skin test, also known as the tuberculin skin test, is a diagnostic tool used to screen for tuberculosis (TB). It involves injecting a small amount of tuberculin under the top layer of the skin on the forearm and then checking for a reaction within 48-72 hours. This test helps identify individuals who have been exposed to the TB bacteria. Sputum culture for acid-fast bacillus (AFB) is used to confirm TB diagnosis in individuals suspected of having active TB. The BCG vaccine is used to prevent severe forms of tuberculosis in high-risk individuals but is not a diagnostic tool. While a chest X-ray can show signs of active TB disease, it is not a primary diagnostic tool for screening purposes.

2. A nurse is preparing for the hospital admission of a client who is suspected to have active tuberculosis (TB). Which of the following precautions should the nurse plan to implement to safely care for this client?

• A. Staff and visitors should wear gowns, masks, and gloves while in the client's room.
• B. The client should be placed in a private room with a special ventilation system.
• C. The client may be placed in a room with other clients who require droplet isolation precautions.
• D. The protocol for donning and removing personal protective equipment before entering or leaving the room of a client with TB is different than for clients who are in other types of isolation.

Correct answer: B

Rationale: When caring for a client suspected of having active tuberculosis (TB), it is essential to place the client in a private room with a special ventilation system to prevent the spread of TB bacteria to others. Choice A is incorrect because staff and visitors should wear respiratory protection, not just gowns, masks, and gloves. Choice C is incorrect as clients with TB should not be placed in a room with other clients, as they need to be isolated to prevent transmission. Choice D is incorrect because the protocol for donning and removing personal protective equipment for clients with TB is similar to other types of isolation, focusing on proper infection control measures.

3. A client who is HIV-positive, has pneumonia and is not responding to antibiotic therapy may have active pulmonary tuberculosis (TB) due to exposure history and symptoms of night sweats and hemoptysis. Which test is the most reliable to confirm the diagnosis of active pulmonary TB?

• A. Chest x-ray
• B. Presence of bronchophony
• C. Mantoux test
• D. Sputum culture for acid-fast bacillus

Correct answer: D

Rationale: The correct answer is D: Sputum culture for acid-fast bacillus. The most reliable test to confirm the diagnosis of active pulmonary TB is the sputum culture for acid-fast bacillus. This test helps identify the presence of Mycobacterium tuberculosis, the causative agent of TB, in the sputum. Chest x-rays can show characteristic findings of TB but are not as reliable as sputum cultures for confirmation. Bronchophony is a test for assessing vocal resonance and is not specific for TB diagnosis. The Mantoux test is a screening test for TB exposure but cannot confirm active disease.

4. A nurse is caring for a client who has active pulmonary tuberculosis (TB). The client is on airborne precautions and is being treated with multidrug therapy. A chest x-ray is scheduled for the client. Which of the following is not a precaution the nurse should take to safely transport the client to x-ray?

• A. Ask the x-ray technician to come to the client's room to perform a portable x-ray.
• B. Have the client wear a mask.
• C. Notify the x-ray department that the client is on airborne precautions.
• D. Wear a filtration mask and gloves for protection against the client's microorganisms.

Correct answer: A

Rationale: The correct answer is to ask the x-ray technician to come to the client's room to perform a portable x-ray. This option minimizes the risk of exposing other individuals to the client's infectious microorganisms during transport. Having the client wear a mask (Choice B) and notifying the x-ray department about airborne precautions (Choice C) are crucial precautions to prevent the spread of infection. Additionally, wearing a filtration mask and gloves (Choice D) is essential for the nurse's protection when in direct contact with the client, but it is not directly related to transporting the client to the x-ray department.

5. A provider is discharging a client with a prescription for home oxygen therapy. Client and family teaching by the nurse should include all of the following instructions except?

• A. Cleanse the mask or collar with soapy water every other day.
• B. Ensure that the straps on the mask are secure but not too tight.
• C. Apply petroleum jelly around and inside the nares.
• D. Post 'no smoking' warning signs at home in a prominent location.

Correct answer: C

Rationale: When providing instructions for home oxygen therapy, it is important to ensure safety and proper care. Choices A, B, and D are all essential instructions for the client and family. Choice C, 'Apply petroleum jelly around and inside the nares,' is incorrect. Petroleum jelly should not be used near oxygen sources as it is flammable and can increase the risk of fire hazard. Therefore, this instruction should not be included in the teaching.

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